With more than two million page views and more than 4,500 items, this blog provides news and commentary on public policy, business and economic issues related to the $3 billion California stem cell agency, officially known as the California Institute for Regenerative Medicine(CIRM). David Jensen, a retired California newsman, has published this blog since January 2005. His email address is djensen@californiastemcellreport.com.

Monday, October 30, 2017

At one point in its history, the $3 billion California stem cell agency had only about as many employees as a 24-hour Burger King, probably fewer.

Today it is has 46 workers, most of whom labor behind the scenes, rarely visible to the public. They do what I call "invisible work." That means you only see it when it goes away. Then the job that once was performed very well with little notice draws great and sometimes anxious attention because the work -- all of a sudden -- is not getting done.

Last week the California Institute for Regenerative Medicine (CIRM), as the agency is formally known, to its credit moved to recognize some of those workers, which the agency calls team members.

"I don’t have the word space in this blog to introduce you to them all so, for today, say hello to a few of our 2017 CIRM Game Ball winners. At our quarterly Team meetings, we honor and celebrate members whose efforts reflect our 'All In' culture with this award."

They ranged from Lilia Leal, a finance officer, to Paul Webb, a senior science officer. Webb received his game ball for completing 40 of the important clinical advisory panel sessions in less than six months. Leal won her ball for reducing grant payment time by 30 days.

We recommend the Dubnicoff item if you want to improve, however slightly, your understanding of CIRM and how it tries to make science happen. And congratulations to all the Game Ball winners.

Thursday, October 26, 2017

The California stem cell agency today awarded $33 million for clinical trial research, but not before some governing board members questioned the appropriateness of backing an effort to treat osteoarthritis of the knee.

The awards today bring to 43 the number of clinical trials funded by the stem cell agency, formally known as the California Institute for Regenerative Medicine (CIRM). The agency is pushing hard to fulfill the promise of the 2004 ballot campaign that created the $3 billion effort. Clinical trials are the last stage before a treatment can win federal approval.

The agency expects to run out of money in mid 2020, but so far has failed to back research that has resulted in a therapy that is available for widespread use.

At today's telephonic CIRM board meeting, the arthritis research by La Jolla's California Institute for Biomedical Researchencountered opposition from some members of the board who expressed concern that it did not square with the mission of the agency.

At issue was the use of a small molecule drug, KA34, to stimulate stem cells to create new cartilage in knees. Jeff Sheehy, a board member and San Francisco county supervisor, said small molecule development is widely done already by the pharmaceutical industry. Noting that the research is a treatment and not a cure, he said funding the arthritis award would mean not funding other research that would be more focused on direct stem cell cures.

Art Torres, vice chairman of the board and a former state senator, supported the application, declaring that "if we can show we are finding some treatment we may be moving forward to getting support in other ways."

Both men have suffered from severe knee problems. About one in five persons over 45 are afflicted with arthritis of the knee.

The vote by the board on the application, which involves a phase one safety trial, was 9-5. Last month, the agency's grant reviewers, meeting behind closed doors last month, approved the award following a more detailed examination of the proposal.

The largest award, $19.8 million, went to another San Diego area firm, Poseida Therapeutics. A CIRM news release on today's action said the research will test "the safety of a gene modified cell therapy to treat multiple
myeloma, the abnormal growth of malignant plasma cells of the immune
system."

Maria Millan, president of the stem cell agency, said,

“Multiple myeloma disproportionately affects people over the age of 65 and African Americans, and it leads to progressive bone destruction, severe anemia, infectious complications and kidney and heart damage from abnormal proteins produced by the malignant plasma cells. Less than half of patients with multiple myeloma live beyond 5 years.”

About 12,590 deaths are expected from multiple myeloma this year in the United States, according to the American Cancer Society. The award was the first for Poseida from CIRM. The company is providing $8.6 million in co-funding.

Like all the awards today, the Poseida award was approved earlier in a closed door meeting by reviewers who do not have to publicly disclose their economic or professional conflicts of interest.

There was no board discussion today of the Poseida award nor of the third award, $4.8 million to Childrens' Hospital of Los Angeles. Its phase one trial involves testing the feasibility of using engineered T-cells to fight viruses that can kill patients with weakened immune systems. Those patients include persons undergoing chemotherapy, bone marrow or cord blood transplants.

The agency has helped to finance 16 clinical trials in 2017 alone. Whether it will continue at this pace in 2018 is expected to be discussed at its December board meeting. Some board members have indicated it would be of some benefit to slow the pace of funding to extend the life of the agency.

Wednesday, October 25, 2017

What do Benjamin Franklin and Mrs. Silence Dogood have to do with the affairs of the $3 billion California stem cell agency?

Very little -- directly -- is one answer. The other answer is that Ben and the publicly spirited Mrs. Dogood had a lot to do with the publication of strong views that run afoul of the established order.

Ben Franklin, Getty Images

Silence Dogood, you see, was a pen name for Ben early in his career. He used it successfully to get his thoughts into print. It made Franklin, as a writer, anonymous -- thus overcoming the barrier that use of his own name posed.

In advance of today's publication of the comment, ViaCyte was offered, in the spirit of fairness, an opportunity to respond to the anonymous writer. Declining on behalf of the San Diego company was Jessica Yingling, president of Little Dog Communications Inc., of San Diego. She also asked whether “it is normal to have comments like this.”

My email reply to her earlier this week said, yes, it is relatively common to permit anonymous comments on the California Stem Cell Report. As I replied, I thought others were likely to have similar questions. Thus this piece came about.

But first, it is helpful to understand just how anonymous comments work on Blogger, the Google-owned platform for the California Stem Cell Report.

Google allows readers, at the option of the blog publisher, to make comments anonymously. Google controls the method that protects the anonymity of the writer. When I receive an anonymous comment, I do not and cannot know the names of persons who file them. But I do moderate them.

I permit anonymous comments because of the nature of the scientific community, the stem cell agency and the biotech industry. Of particular importance is that the agency is, in fact, a state government body and is spending public money. However, it is not answerable to the governor or the legislature because of the terms of the ballot measure that created it, Prop. 71. That is not the case for nearly all other state agencies. Currently the agency, formally known as the California Institute for Regenerative Medicine (CIRM), also functions almost invisibly with little attention from any media, mainstream or otherwise.

Over the past 13 years of writing about this rather large source of public funding for stem cell research, I have found that many persons in the field are reluctant to comment with complete candor, sometimes because it may appear to others in the field that their comments are unseemly. In other cases, people in the field are simply afraid of possible financial or professional repercussions if they make comments that some may find objectionable, no matter how well founded. If anonymous comments were barred entirely, it would mean a loss of a certain perspective about the agency and sometimes useful information about how the stem cell industry and the agency works. That said, not all anonymous comments satisfy that criteria.

I do not publish all anonymous comments. Some have been libelous. A few have been deranged. Others are nothing more than spam.

Reasonable people can and do differ about the use of anonymous comments on blogs or in the mainstream media, which are very different animals. During my decades of covering and editing news as well as directing coverage, use of anonymous sources has always been a matter of debate and controversy. I acknowledge that some, perhaps many, anonymous writers may be grinding a particular axe. On the other hand, the targets of such comments are not always forthright. It is not necessarily in their interests to disclose bad news. The media can also be easily manipulated by "official" sources, something I have seen occur widely over the past five decades.

Indeed, the backers of Prop. 71 in 2004 were less than forthright during ballot campaign that created the stem cell agency. But such is the nature of such political activities.

Ben Franklin was an adroit politician as well as a clever writer and advocate. He also hid his identity under many pen names during his life in the 18th century. Today I have no doubt that Silence Dogood would have no difficulties with our judicious posting of anonymous comments on the California Stem Cell Report.

For those of you would like to comment on this topic, please feel free. Just click on the word “comments” at the end of this item. Perhaps we will hear from some of Mrs. Dogood’s descendants.

The one-hour session will be at the Cedars-Sinai Medical Center from noon to 1 p.m. In addition to Jonathan Thomas, chairman of the California Institute for Regenerative Medicine (CIRM), and Maria Millan, CEO of CIRM, three speakers from Cedars are scheduled.

They are Shlomo Melmed, Cedars-Sinai executive vice president and a member of the CIRM board; Eduardo Marbán, director of the Cedars Heart Institute, and Clive Svendsen, director, Cedars Board of Governors Regenerative Medicine Institute.

Sunday, October 22, 2017

ViaCyte, Inc., is a San Diego stem cell firm working on what could be a virtual cure for diabetes -- one that the $3 billion California stem cell agency has supported handsomely for years.

UC Davis researcher Paul Knoepfler last week carried a piece on his blog on ViaCyte's progress. The article came in the form of a Q&A with the firm's president, Paul Laikind.

Paul Laikind, CEO Viacyte

The interview covered a lot of scientific ground as well as some financial matters dealing with the firm and its clinical trials. Perhaps a good part of the bottom line was contained in this paragraph from Laikind.

"Near term, as the PEC-Direct clinical trial advances into Cohort 2, full enrollment is expected in the second half of 2018 with evaluation of efficacy about 6 months later. The primary efficacy endpoint is clinically relevant insulin production, as measured by C-peptide 6 months after implantation. While the efficacy analysis is expected to occur in 2019, patients will remain in the study for two years, thus the expected completion date for the Phase 1/2 study is December 2020."

"The goal of the research agreement with W.L. Gore & Associates is to cooperatively establish new methods of effectively delivering cell therapies, specifically with improvements in the Encaptra Cell Delivery System used in PEC-Encap. The semipermeable membrane that is a key component of the Encaptra device is made of the same material that makes up Gore-Tex. The Gore team are the world’s leading experts for manipulating and engineering this material.

"Gore has expertise in medical device development and drug delivery technologies, as well as previous research and development experience on cell encapsulation and implant programs for diabetes. Gore’s contribution to the material and design improvements of the Encaptra Cell Delivery System is expected to support the reliable and robust long-term engraftment that is required for the PEC-Encap product to be most effective.

"Gore’s participation in ViaCyte’s financing announced in May 2017 represents another external validation of the company and its technologies. It also reflects Gore’s great interest in, and commitment to, the development of a successful implantable cell therapy for all patients with diabetes who use insulin."

Friday, October 20, 2017

The Los Angeles Times this morning carried a piece that praised the state's first-in-the-nation disclosure law concerning unregulated stem cell treatments, but the article also questioned whether the law is tough enough for the task.

Business columnist Michael Hiltzik wrote that the law, which goes into effect in January, is "a major step to address an emerging public health crisis." But, he continued,

"(T)here’s reason to ask whether California’s law goes far enough to regulate businessesexploiting the desperation of patients with intractable diseases."

The law targets the more than 100 clinics in California that sell what Hiltzik described as "unlicensed, unproven — and sometimes disproven — stem-cell 'treatments.'" For the first time, such California clinics will be required to disclose to their customers that the treatments are not approved or regulated by the federal government. The notices will advise the customers to consult with their physicians prior to treatment.

Hiltzik, however, questioned the optimistic wording of the disclosure which says that the treatments have "not yet" been approved by the Food and Drug Administration (FDA). He said,

"This suggests that FDA endorsement may only be a matter of time — that
the treatments may be premature, but not fictitious. That’s wildly
optimistic and may itself foster a false hope for the treatments."

Hiltzik, a Pulitzer Prize winner, said the state's Medical Board, which is charged with enforcement, has not been provided with funding to take on the clinics. Plus, he said the board, at best, is a "reluctant regulator."

State Sen. Ed Hernandez, D-Azusa, authored the law. He told Hiltzik the measure is a first step. Hiltzik quoted the legislator as saying,

“Because it’s so new, we’re trying to figure out the best way to start the conversation.”

Hiltzik concluded,

"But
lawmakers and regulators may need to move faster. What will make a
difference in California may not be how the conversation starts, but
where it leads."

The trial, the final one before possible approval for widespread use of the therapy, is expected to include about 200 patients. The California component is being conducted at UC Irvine for the firm, BrainStorm Cell Therapeutics.

The $3 billion California stem cell agency, known formally as the California Institute for Regenerative Medicine (CIRM), awarded the cash to BrainStorm last July. The agency's reviewers said of the application:

"Overall, the proposed phase 3 study is well-designed. If executed successfully, it will provide a very meaningful outcome, generating data to define the overall value of the program and the path to regulatory approval and marketing.

"The investigators have now included slow vital capacity as a clinical measure in the revised clinical trial per (earlier reviewer) recommendations .

"The current protocol will still not answer the question of whether the product is better than untreated autologous bone marrow-derived MSCs. However, reviewers felt this is not critical for the current study as a positive outcome in this trial may allow a demonstration of superiority over MSC alone in a future study."

The firm has matched the California award with another $16 million. Completion date of the trial is 2019. The trial is one of two phase three trials backed by CIRM that are currently recruiting. The principal investigator at UC Irvine is Namita A. Goyal. More information on the trial can be found here.

About 5,600 people in the United States are diagnosed annual with ALS, which has severely disabled British physicist Stephen Hawking.Sphere: Related Content

California's $3 billion stem cell agency went dark on the Internet earlier this week, the second time it has had a significant Internet outage in recent months.

The outage began on Monday afternoon. The agency was back up by Tuesday at about 7 p.m. The California Institute for Regenerative Medicine (CIRM), as the agency is formally known,. reported that the problem did not affect internal work but did affect public access to agency information. It also blocked any incoming email or outgoing email. However, all of the email went through after the problem was solved.

In response to a question from the California Stem Cell Report, Kevin McCormack, senior director for communications, said,

"At about 1 p.m.
on Monday 10/9/2017 our external Domain Name System (DNS) provider
dropped our DNS records, that meant people looking for our website,
blog, GMS(grant management system), and email
servers were unable to access them as DNS converts names (like www.cirm.ca.gov) into an IP (internet protocol) address (like 192.168.2.3) so that the appropriate server may be accessed by your browser.

"We
are working with our DNS provider to find out the root cause of that
event. In the meantime, we brought up a new external DNS server with
another provider to restore name
resolution.

"The servers for www.cirm.ca.gov and grants.cirm.ca.gov were themselves unaffected in that they continued to operate as normal awaiting requests - but without external
DNS converting names into IP addresses, no requests would come to those servers from outside of CIRM.

"CIRM
staff and the GWG (grant application reviewers) then meeting at CIRM were still able to continue
as usual accessing the GMS since they were using internal DNS servers.
Similarly, all purely
internal email within CIRM was unaffected - however, because we were
without external DNS, any email coming into or out of CIRM was not
delivered."

Editor's note: An earlier version of this incorrectly stated that the problem was the first significant outage for the agency.
Sphere: Related Content

The new tool is called the clinical trials dashboard. It is a major improvement in making information on the all-important trials more easily available to the public, patients, researchers and policy makers.

The new dashboard cuts through the online maze and allows readers to sort by disease areas, investigator and institution, among other things. It also shows quickly the status of each trial, whether it is recruiting and takes the reader to a contact if he or she is interested in participating in a trial.

As the main dashboard page shows, the agency, formally known as the California Institute for Regenerative Medicine (CIRM), has funded 40 trials. The dashboard allows you to see which are still active and which are still recruiting. If you are interested in cancer and solid tumors, filtering them out is simple. Just click on the blue box on the dashboard.

Want to know which institution has the most CIRM-backed trials? The answer is UCLA with five, a figure easily arrived at by using the new CIRM tools. That goes for investigators as well. The dashboard can show you that Donald Kohn of UCLA has the highest number of trial awards with three. A bunch of others have two each.

CIRM has long had a vast array of information on its website. As with any website, that presents a challenge in terms of making the information available to public. First, the public needs to know it is there. Next, they need to be able to actually find the relevant information and find it relatively easily. Removing barriers to online access is critical. The online tools also must fill a wide range of information needs. A cancer patient or researcher is not likely to be interested in plowing through reams of eye disease information in order to gain access to the relevant cancer data.

The clinical trial dashboard was built by Karen Ring, CIRM's website manager and a former stem cell researcher, along with contributions from numerous others on the agency's team. It is a major step forward in the agency's effort to tell the CIRM story and how it has spent the billions provided by California taxpayers.

Here is a video that turned up this morning as I navigated my way through the clinical trial dashboard. Another note: I did not encounter any bugs this morning, but Ring says she will be tweaking the dashboard and improving it in the next couple of weeks.Sphere: Related Content

Sunday, October 08, 2017

A couple of die-hard opponents of the $3 billion California stem cell agency minced no words this weekend. In an op-ed piece in the Orange County Register, they described the agency as nothing more than an "advanced high school science project."

They described the agency's efforts as "dismal" and declared that "this disappointing abuse of taxpayer dollars" should be terminated.

The print version of the article appeared in Sunday's paper, which has a circulation of about 312,000. Both the print and online version carried photographs involving stem cell research. But neither was from UC Irvine, which has received $108 million from the agency and has a member on the board of the California Institute for Regenerative Medicine (CIRM), as the agency is formally known. UC Irvine is located only 17 minutes away from the offices of the newspaper.

The piece is a relatively tame preview of the rhetoric that will confront CIRM if it goes to the ballot in 2020 for more billions from California taxpayers. The article cited arguments from the 2004 Prop. 71 ballot measure campaign that created the agency.

"But actual outcomes for these promised advances are speculative at best and nonexistent at worst. Similar benefits were promised to the California economy to 'generate millions of new tax dollars.'

"With such a dismal record, this would be a good time to shut the spigot on issuing the remaining $345 million — meaning some $690 million would be saved by state taxpayers. That money could be better spent on pensions, schools, roads, housing or better basic medical care for our residents."

As for the high school project business, the article said CIRM "continues to operate as a kind of advanced high-school science project, instead of moving toward the cures promised to voters in Prop. 71."

Thursday, October 05, 2017

Interest in California stem cell matters spiked in mid-week but still is well below the interest in broader matters, such as stem cell therapies, according to Google search data this morning.

Searches using the term "California stem cells" shot up 43 percent in midweek, Google reported. Just exactly why more people were searching on the term is not clear, but the Google data shows a definite high point.

The scale of 1 to 100 on the charts with this item reflects the level of interest -- not numbers of readers or page views. One-hundred shows the peak interest level only. Actual numbers were not disclosed by Google.

Readers can see the trends in the two Google-generated charts attached to this item, which have an important caveat. The charts are live and updated automatically by Google as long as they are posted.

My take on the information is that at this point it is more of a curiosity than of any major signficance. However, in the event of major stem cell news, the data might have more value.Sphere: Related Content

Wednesday, October 04, 2017

Beginning next year, California will have a new law that imposes the first-ever disclosure requirements on currently unregulated stem cell clinics that offer therapies that have not been approved by the Food and Drug Administration.

The measure is the first of its kind in California and probably the entire nation. Authored by state Sen. Ed Hernandez, D-West Covina, it will require clinics to specifically notify its customers that he or she is about to undergo a treatment not approved by the FDA. The notification also must include advice encouraging customers to consult their primary care physician prior to undergoing a stem cell therapy.

A legislative analysis of the bill, SB512, cited a statement from the Center for Public Interest Law that said,

"It is critical to patient safety that these individuals are not misled into believing they are partaking in an FDA-approved clinical trial and assuming serious health and financial risks in the process. The disclosure notices required by this bill are an important step in ensuring that patients have the information they need before making such monumental decisions about their treatment."

Paul Knoepfler, UC Davis photo

Knoepfler co-authored a research paper in 2015 that documented the presence of nearly 600 unregulated clinics nationwide with California leading the way. He wrote on his blog,

"Taken together, the provisions of this law will help consumers
learn more about the stem cell clinic industry, make better decisions
about their health and that of their loved ones, and delineate the
difference between stem cell clinics versus compliant researchers
conducting stem cell clinical trials with FDA approval.

"In the big picture, this new California law plus a more active FDAon
the stem cell front together give me more hope that the wild west of
stem cell clinics can be reined in sooner rather than later! Perhaps
other states will follow suit with new laws and state medical boards
will get more involved in overseeing stem cell therapies. With more 570 stem cell clinics in the US and more than 100 here in California alone, more efforts like these are needed on the consumer protection and educational outreach front."

Knoepfler deserves great credit for his efforts regarding unregulated clinics. It is fair to say that without his work, California would not have seen this law at this time. He was the first to document the size of the industry with the 2015 article, co-authored by Leigh Turner of the University of Minnesota. Their work makes it abundantly clear that scientists can make a real difference on public policy issues if they are persistent and effective. One of Knoepfler's key tools was blogging, a practice that some scientists think is less than dignified. Nonetheless, his blogging helped to elevate the issue and served as a source for the news media as they looked into the matter.

Monday, October 02, 2017

A California stem cell trial backed with $21 million in state cash has generated "super, super-exciting" results involving patients who were paralyzed as the result of severe spinal cord injuries.

A story today by Erin Allday in the San Francisco Chronicle said,

"Four out of six paralyzed patients who had 10 million stem cells
transplanted into their spinal cords have shown striking improvement a
year after treatment, including increased ability to move their hands
and arms and to perform basic functions like feeding and bathing
themselves, according to research results being released Monday.

"All six patients in the early-stage clinical trial, conducted by
Fremont’s Asterias Biotherapeutics, reported at least some recovery
after the stem cell transplant. The trial is among the first to use
embryonic stem cells in human subjects.

"It’s too soon to know for sure that the stem cells were solely
responsible for the patients’ improvement. The patients could have
experienced a spontaneous recovery, which is not unheard of in spinal
cord injury victims, or their improvement could be the result of intense
rehabilitation.

"But compared to a large
group of people with similar injuries, the results among patients
treated with stem cells were remarkable, said doctors and scientists
involved with research.

Allday also wrote,

“Scientifically, I have to say we don’t know for sure if it’s the stem
cells. But I’ve been treating these kinds of patients for 30 years, and
I’ve never seen anything like this before,” said Dr. Richard Fessler,
lead investigator of the Asterias trial and a professor in the
department of neurosurgery at Rush University Medical Center in Chicago."

The Chronicle story continued,

"'The bottom line is super, super exciting. Well beyond anything I
thought we could have achieved at this point,' said Dr. Edward Wirth,
chief medical officer with Asterias."

The story was good news for the California Institute for Regenerative Medicine (CIRM), as the $3 billion, state stem cell agency is formally known and which has pumped the $21 million into the work. However, the bad news was that the agency's support of the research was not mentioned until the last paragraph of the Chronicle story. Most readers are not likely to get that far.

The agency has had a tough time getting its successes into the mainstream media for a number of years. But its story is now more important for the agency and will be for the new next three years. It is scheduled to run out of money for new awards in mid 2020. It is currently examining funding options including the possibility of asking voters for another multi-billion dollar bond issue. The nearly 13-year-old effort has not yet fulfilled voter expectations of development of a widely available therapy. Without something dramatic to show voters, a bond issue is likely to have heavy going.

The agency also put out a news release on the developments as did Asterias. However, a check with Google at 4 p.m. Monday showed that no other newspapers or other major mainstream outlets have picked up the story yet.

The news seemed to benefit the price of Asterias stock. It rose nearly 6 percent today, closing at $3.20. Its 52-week high is $5.80 and its 52-week low is $2.83.super
Sphere: Related Content

About Me

The California Stem Cell Report is the only nongovernmental website devoted solely to the $3 billion California stem cell agency. The report is published by David Jensen, who worked for 22 years for The Sacramento Bee in a variety of editing positions, including executive business editor and special projects editor. He was the primary editor on the 1992 Pulitzer Prize-winning series, "The Monkey Wars" by Deborah Blum, which dealt with opposition to research on primates. Jensen served as a press aide in the 1974 campaign and first administration of Gov. Jerry Brown. (Time served: two years and one week.) He writes from his sailboat on the west coast of Mexico with occasional visits to land. Jensen began writing about the stem cell agency in 2005, noting that it is an unprecedented effort that uniquely combines big science, big business, big academia, big politics, religion, ethics and morality as well as life and death. The California Stem Cell Report has been identified as one of the best stem cell sites on the Internet. Its readership includes the media (both mainstream and science), a wide range of academic/research institutions globally, the NIH and California policy makers.